Despite widespread awareness and use of scientifi cally proven life-prolonging medical and device-based therapies over the last two decades,heart failure remains a leading cause of morbidity,mortality,and health care ...Despite widespread awareness and use of scientifi cally proven life-prolonging medical and device-based therapies over the last two decades,heart failure remains a leading cause of morbidity,mortality,and health care expenditure in the United States.Mechanical circulatory support with a continuous-fl ow left ventricular assist device(CF-LVAD),either as a bridge to heart transplantation or as destination therapy,is an increasingly used treatment modality for patients with advanced heart failure syndromes that worsen despite their receiving standard therapies.CF-LVAD support creates unique hemodynamic alterations that must be understood to provide appropriate care for these patients before and after implantation.Echocardiography is essential in the evaluation of patients who are being considered for or are mechanically supported by CF-LVADs.Here we provide a focused clinical review on the use of echocardiography in two main aspects of the evaluation of these patients:(a)optimal patient selection for CF-LVAD support and(b)followup assessment of optimal pump function.展开更多
Demographic trends worldwide show a progressively aging population and an increase in the overall medical complexity of elderly patients with cardiovascular disease.Elderly patients,especially those aged 75 or older,a...Demographic trends worldwide show a progressively aging population and an increase in the overall medical complexity of elderly patients with cardiovascular disease.Elderly patients,especially those aged 75 or older,are relatively underrepresented in many of the clinical trials that helped create major society guidelines for evaluation and management of ischemic heart disease.Consequently,risk benefi t ratios of a guideline-based approach in these patients are not well defi ned,especially with regards to pharmacotherapies and percutaneous coronary interventions.In this article we offer a practical approach to defi ning the elderly population,and provide an evidenced based review of the diagnostic and therapeutic implications of advanced age in the evaluation and management of ischemic heart disease.展开更多
Heart Failure(HF)and Atrial Fibrillation(AF)are common diseases which lead to signifi cant morbidity and mortality.Each disease can be a challenge to treat clinically,especially when they present together.We performed...Heart Failure(HF)and Atrial Fibrillation(AF)are common diseases which lead to signifi cant morbidity and mortality.Each disease can be a challenge to treat clinically,especially when they present together.We performed a review of the literature including clinical trials,metanalyses,and guidelines regarding the management of patients with HF and AF.This review describes the pathophysiologic mechanisms behind each disease state,their associated prognosis,and epidemiologic features.Strategies for prevention of stroke in patients with AF,including use of novel oral anticoagulants as well as prevention of the development of AF are discussed.We review the medical and catheter-based therapies for AF and present an original algorithm for the management of AF in patients with HF.展开更多
文摘Despite widespread awareness and use of scientifi cally proven life-prolonging medical and device-based therapies over the last two decades,heart failure remains a leading cause of morbidity,mortality,and health care expenditure in the United States.Mechanical circulatory support with a continuous-fl ow left ventricular assist device(CF-LVAD),either as a bridge to heart transplantation or as destination therapy,is an increasingly used treatment modality for patients with advanced heart failure syndromes that worsen despite their receiving standard therapies.CF-LVAD support creates unique hemodynamic alterations that must be understood to provide appropriate care for these patients before and after implantation.Echocardiography is essential in the evaluation of patients who are being considered for or are mechanically supported by CF-LVADs.Here we provide a focused clinical review on the use of echocardiography in two main aspects of the evaluation of these patients:(a)optimal patient selection for CF-LVAD support and(b)followup assessment of optimal pump function.
文摘Demographic trends worldwide show a progressively aging population and an increase in the overall medical complexity of elderly patients with cardiovascular disease.Elderly patients,especially those aged 75 or older,are relatively underrepresented in many of the clinical trials that helped create major society guidelines for evaluation and management of ischemic heart disease.Consequently,risk benefi t ratios of a guideline-based approach in these patients are not well defi ned,especially with regards to pharmacotherapies and percutaneous coronary interventions.In this article we offer a practical approach to defi ning the elderly population,and provide an evidenced based review of the diagnostic and therapeutic implications of advanced age in the evaluation and management of ischemic heart disease.
文摘Heart Failure(HF)and Atrial Fibrillation(AF)are common diseases which lead to signifi cant morbidity and mortality.Each disease can be a challenge to treat clinically,especially when they present together.We performed a review of the literature including clinical trials,metanalyses,and guidelines regarding the management of patients with HF and AF.This review describes the pathophysiologic mechanisms behind each disease state,their associated prognosis,and epidemiologic features.Strategies for prevention of stroke in patients with AF,including use of novel oral anticoagulants as well as prevention of the development of AF are discussed.We review the medical and catheter-based therapies for AF and present an original algorithm for the management of AF in patients with HF.
